Key result
Right internal jugular PAC safely traverses an unrecognized PLSVC without complications.
Case Report (n=1)
This case highlights the importance of ruling out persistent left superior vena cava and associated anomalies in patients presenting with a dilated coronary sinus on echocardiography.
Recognizing undiagnosed LSVC may avert PAC misplacement; this case leaves open the utility of routine preoperative imaging.
We present a case of pulmonary artery catheter (PAC) placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC) and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.
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Lee et al. (2015) conducted a case report in Persistent left superior vena cava (n=1). Pulmonary artery catheterization was evaluated. A pulmonary artery catheter was incidentally placed through the right internal jugular vein, bridging vein, and coronary sinus in a patient with an unrecognized persistent left superior vena cava without complications.
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